| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - WI | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.59% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - WI | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.37% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 13.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - WI | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 4.67% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | — |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $99 | — | $99 | — |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - WI | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $47 | $47 | — |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC. | 70 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $59K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $25K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 108 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.